Arterial stiffness and lower extremities arterial disease – cross-sectional study of general practice patients

Anna Kamieńska, Aleksandra Danieluk, Marta Maria Niwińska, Slawomir Chlabicz

Keywords: atherosclerosis, lower extremities arterial disease, arterial stiffness

Background:

The early diagnosis of atherosclerosis remains an important task for family medicine doctors. Lower extremities arterial disease (LEAD) is one of clinical presentations of peripheral atherosclerosis. The diagnosis of LEAD in primary care is based on history of claudication, physical examination (weakened or absent peripheral pulses) and decreased ankle-brachial index (ABI).

Research questions:

Could arterial stiffness parameters be useful in early detection of LEAD?

Method:

A cross-sectional study was performed among general practice patients over 50 years of age. We collected information about risk factors for cardiovascular disease and about established cardiovascular disease. All participants were interviewed with Edinburgh Claudication Questionnaire. We also performed pulse wave velocity (PWV) evaluation with Mobil-O-Graph Pulse Wave Analyser (PWA) and ABI measurements with Huntleigh-Dopplex. We compared PWV with ABI measurements and occurrence of other cardiovascular risk factors, history of established cardiovascular disease, clinical symptoms and signs of LEAD and score on Edinburgh Claudication Questionnaire. The statistical analysis was performed with the use of IBM SPSS Statistics 25.

Results:

A study including 290 participants revealed that increased PVW over a set threshold over 10m/s correlated positively with older age (χ2 = 101,93; p < 0,001), presence of diabetes mellitus (χ2 = 8,27; p = 0,004), presence of elevated blood pressure (χ2 = 12,70; p < 0,001) and absence of posterior tibial pulse (χ2 = 3,86; p = 0,049) as well as with decreased ABI (χ2 = 5,80; p = 0,016). We found no correlation between elevated PVW and coronary artery disease (χ2 = 2,59; p = 0,108), smoking (χ2 = 5,61; p = 0,060), presence of claudication (χ2 = 0,94; p = 0,334).

Conclusions:

Pulse wave velocity may be an additional parameter in early identification of lower extremities arterial disease as it correlates with other well verified risk factors.

Points for discussion:

Can we measure arterial stiffness parameters in family medicine consulting room?

Is arterial stiffness a new cardiovascula risk factor to detect in primary care?

Is ankle brachial index to be deposed as LEAD index?